High risk and poor prognostic features determining aggressiveness of disease in post operative locally advanced cases of oral cavity carcinoma: an institutional experience

Abstract

Locally advanced oral cavity cancer is managed in multidisciplinary setting including surgery followed by postoperative radiotherapy (PORT) and chemotherapy. We also follow the same protocol however during the active treatment only our patients had recurrence of disease. We enrolled 16 cases of locally advanced oral cavity cancer seen from September to November 2015 at our Radiation Oncology department. Most common presentation is age group of 31-40 years and 14 cases were males out of 16. The pattern of presentation included cases as 9 carcinoma tongue, 5 carcinoma buccal mucosa, 1 carcinoma angle of mouth and 1 carcinoma of lower alveolus. All these patients were operated and referred for PORT. The dose of PORT planned was 60 Gy/30# for 6 weeks along with concurrent cisplatin 30mg/m2 weekly. All these patients by the mid of the treatment developed nodal recurrence confirmed on Biopsy. When the high risk factors were extrapolated it was found that depth was more than 1 cm, base of resection (BOR) was also close all being <0.5 cm and margins being very close the cut off being 0.3 cm. All these patients had their PORT started after 7 weeks of surgery. Age <45 years, depth >1 cm, BOR <0.5 cm and close margins with cut off 0.3 cm, perinodal extension or otherwise presence of perineural invasion were poor prognosis features determining aggressiveness of disease. This study gave an impetus to explore more in such type of poor prognosis patients and we look forward for more insight.